Qualidade dos cuidados de enfermagem e satisfação do paciente atendido em um hospital de ensino

OBJECTIVES: assess the quality of nursing care, the patients' satisfaction and the correlation between both. METHOD: cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients. RESULTS: among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables. CONCLUSION: Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations.OBJETIVOS: evaluar la calidad de los cuidados de enfermería, la satisfacción del paciente y la correlación entre ambos. MÉTODO: estudio trasversal con 275 pacientes internados en un hospital de enseñanza de la región Centro-Oeste de Brasil. Los datos fueron recolectados mediante la aplicación simultánea de tres instrumentos. A seguir, fueron digitalizados en un banco de datos electrónico y analizados en función de la positividad, valor de mediana y coeficientes de correlación de Spearman. RESULTADOS: entre los cuidados de enfermería evaluados, solamente dos fueron considerados seguros - higiene y conforto físico; nutrición e hidratación - y los demás clasificados como pobres. Sin embargo, los pacientes se mostraron satisfechos con los cuidados recibidos en los dominios evaluados: técnico-profesional, confianza y educacional. Eso puede ser justificado por la correlación débil a moderada observada entre esas variables. CONCLUSIÓN: A pesar del déficit de cualidad, fue encontrado alto nivel de satisfacción de los pacientes con los cuidados de enfermería recibidos. Tales resultados indican la necesidad de que la institución centre sus objetivos en un sistema de evaluación permanente de la cualidad del cuidado, visando atender a las expectativas de los pacientes.OBJETIVOS: avaliar a qualidade dos cuidados de enfermagem, a satisfação do paciente e a correlação entre ambos. MÉTODO: estudo transversal, realizado com 275 pacientes internados em um hospital de ensino da Região Centro-Oeste do Brasil. Os dados foram obtidos por meio da aplicação simultânea de três instrumentos. A seguir, foram digitados em banco de dados eletrônico e analisados em função da positividade, valor de mediana e coeficientes de correlação de Spearman. RESULTADOS: dentre os cuidados de enfermagem avaliados, apenas dois foram considerados seguros - higiene e conforto físico; nutrição e hidratação - e os demais foram classificados como pobres. Todavia, os pacientes mostraram-se satisfeitos com os cuidados recebidos nos domínios avaliados: técnico-profissional, confiança e educacional. Isso pode ser justificado pela correlação fraca a moderada observada entre essas variáveis. CONCLUSÃO: apesar do déficit de qualidade, houve alto nível de satisfação dos pacientes com os cuidados de enfermagem recebidos. Tais resultados apontam a necessidade de a instituição centrar seus objetivos num sistema de avaliação permanente da qualidade do cuidado, visando o atendimento das expectativas dos pacientes

Genetic mapping of high caries experience on human chromosome 13

Background: Our previous genome-wide linkage scan mapped five loci for caries experience. The purpose of this study was to fine map one of these loci, the locus 13q31.1, in order to identify genetic contributors to caries.Methods: Seventy-two pedigrees from the Philippines were studied. Caries experience was recorded and DNA was extracted from blood samples obtained from all subjects. Sixty-one single nucleotide polymorphisms (SNPs) in 13q31.1 were genotyped. Association between caries experience and alleles was tested. We also studied 1,481 DNA samples obtained from saliva of subjects from the USA, 918 children from Brazil, and 275 children from Turkey, in order to follow up the results found in the Filipino families. We used the AliBaba2.1 software to determine if the nucleotide changes of the associated SNPs changed the prediction of the presence of transcription-binding site sequences and we also analyzed the gene expression of the genes selected based on binding predictions. Mutation analysis was also performed in 33 Filipino individuals of a segment of 13q31.1 that is highly conserved in mammals.Results: Statistically significant association with high caries experience was found for 11 markers in 13q31.1 in the Filipino families. Haplotype analysis also confirmed these results. In the populations used for follow-up purposes, associations were found between high caries experience and a subset of these markers. Regarding the prediction of the transcription-binding site, the base change of the SNP rs17074565 was found to change the predicted-binding of genes that could be involved in the pathogenesis of caries. When the sequence has the allele C of rs17074565, the potential transcription factors binding the sequence are GR and GATA1. When the subject carries the G allele of rs17074565, the potential transcription factor predicted to bind to the sequence is GATA3. The expression of GR in whole saliva was higher in individuals with low caries experience when compared to individuals with high caries experience (p = 0.046). No mutations were found in the highly conserved sequence.Conclusions: Genetic factors contributing to caries experience may exist in 13q31.1. The rs17074565 is located in an intergenic region and is predicted to disrupt the binding sites of two different transcription factors that might be involved with caries experience. GR expression in saliva may be a biomarker for caries risk and should be further explored. © 2013 Küchler et al.; licensee BioMed Central Ltd

Psychological impact of visible differences in patients with congenital craniofacial anomalies

© 2015, Singh and Moss; licensee Springer. Background: Patients with craniofacial anomalies often have appearance concerns and related social anxiety which can affect their quality of life. This study assessed the psychological impact of facial and dental appearance in patients with craniofacial anomalies in comparison to a general population control group. Methods: The study involved 102 adult patients (51% male) with congenital craniofacial anomalies and 102 controls (49% male). Both groups completed the Nepali version of Derriford Appearance Scale (DAS) and the Psychological Impact of Dental Aesthetic Questionnaire (PIDAQ) in a clinical setting to assess appearance-related distress, avoidance, and anxiety. Results: There was a significant difference between patients and controls on both PIDAQ (mean score for patients 33.25 ± 9.45 while for controls 27.52 ± 5.67, p < 0.001) and DAS59 scores (mean score for patients 159.16 ± 31.54 while for controls 77.64 ± 6.57, p < 0.001), indicating that patients experienced greater negative psychological impact of living with their appearance (PIDAQ) and more appearance-related distress (DAS) than controls. DAS scores were not associated with gender. There was no association of the place of residence (rural vs. urban) with PIDAQ or DAS59 scores. Conclusions: There is a significant psychological impact of altered facial and dental appearance in patients with craniofacial anomalies compared to controls. There was no effect of locality (rural/urban) on the psychological impact of facial and dental appearance in patients

Role of estrogen related receptor beta (ESRRB) in DFN35B hearing impairment and dental decay

Background: Congenital forms of hearing impairment can be caused by mutations in the estrogen related receptor beta (ESRRB) gene. Our initial linkage studies suggested the ESRRB locus is linked to high caries experience in humans.Methods: We tested for association between the ESRRB locus and dental caries in 1,731 subjects, if ESRRB was expressed in whole saliva, if ESRRB was associated with the microhardness of the dental enamel, and if ESRRB was expressed during enamel development of mice.Results: Two families with recessive ESRRB mutations and DFNB35 hearing impairment showed more extensive dental destruction by caries. Expression levels of ESRRB in whole saliva samples showed differences depending on sex and dental caries experience.Conclusions: The common etiology of dental caries and hearing impairment provides a venue to assist in the identification of individuals at risk to either condition and provides options for the development of new caries prevention strategies, if the associated ESRRB genetic variants are correlated with efficacy. © 2014 Weber et al.; licensee BioMed Central Ltd

Evolution of cuticular hydrocarbons in the hymenoptera : a meta-analysis

Chemical communication is the oldest form of communication, spreading across all organisms of life. In insects, cuticular hydrocarbons (CHC) function as the chemical recognition cues for the recognition of mates, species and nest-mates in social insects. Although much is known about the function of individual hydrocarbons and their biosynthesis, a phylogenetic overview is lacking. Here we review the CHC profiles of 241 species of hymenoptera, one of the largest and important insect orders, including the Symphyta (sawflies), the polyphyletic Parasitica (parasitoid wasps) and the Aculeata (wasps, bees and ants). We investigated whether these five major taxonomic groups differed in the presence and absence of CHC classes and whether the sociality of a species (solitarily vs. social) had an effect on CHC profile complexity. We found that the main CHC classes (i.e., n-alkanes, alkenes and methylalkanes) were all present early in the evolutionary history of the hymenoptera, as evidenced by their presence in ancient Symphyta and primitive Parasitica wasps. Throughout all groups within the Hymenoptera the more complex a CHC the fewer species that produce it, which may reflect the Occam's razor principle that insects’ only biosynthesize the most simple compound that fulfil its needs. Surprisingly there was no difference in the complexity of CHC profiles between social and solitary species, with some of the most complex CHC profiles belonging to the Parasitica. This profile complexity has been maintained in the ants, but some specialisation in biosynthetic pathways has led to a simplification of profiles in the aculeate wasps and bees. The absence of CHC classes in some taxa or species may be due to gene silencing or down-regulation rather than gene loss, as evidenced by sister species having highly divergent CHC profiles, and cannot be predicted by their phylogenetic history. The presence of highly complex CHC profiles prior to the vast radiation of the social hymenoptera indicates a 'spring-loaded' system where the diverse CHC needed for the complex communication systems of social insects, were already present for natural selection to act upon rather than evolve independently. This would greatly aid the multiple evolution of sociality in the Aculeata

MMP13 polymorphism decreases risk for dental caries

Recent evidence suggests that genetic studies may contribute to a better understanding of individual susceptibility to caries. Matrix metalloproteinases (MMPs) and their tissue inhibitors have been suggested to be involved in the caries process. The purpose of this study was to determine if polymorphisms in MMP2 (rs243865), MMP9 (rs17576), MMP13 (rs2252070), and TIMP2 (rs7501477) were associated with caries. Eligible unrelated children and adolescents were evaluated using a cross-sectional design. Data on oral health habits was obtained through a questionnaire and caries data was collected by clinical examination. Genotyping of the selected polymorphisms was carried out by real-time PCR. Allele and genotype frequencies were compared between individuals with and without caries experience. Of 505 subjects, 212 were caries-free and most subjects (61.2%) had mixed dentition. Allele frequency of MMP2, MMP13 and TIMP2 was different between caries-affected and caries-free individuals, with significant association for MMP13 (p = 0.004). Mutant allele carriers for MMP13 demonstrated a significantly decreased risk for caries (OR = 0.538, 95% CI 0.313-0.926); this result remained significant after adjustment for candidate genes, type of dentition and dietary factors. Allelic and genotype frequencies of the polymorphism in MMP9 were similar in caries-affected and caries-free individuals. Genetic variations in MMP13 may contribute to individual differences in caries susceptibility. Our findings reinforce that susceptibility to caries results from gene-environment interactions. Copyright © 2012 S. Karger AG, Basel